Healthcare Provider Details

I. General information

NPI: 1215891254
Provider Name (Legal Business Name): WILMA ESCANILLA RELLORA III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 MILL POINT CIR
NORTH LAS VEGAS NV
89032-0700
US

IV. Provider business mailing address

4012 MILL POINT CIR
NORTH LAS VEGAS NV
89032-0700
US

V. Phone/Fax

Practice location:
  • Phone: 812-760-5478
  • Fax:
Mailing address:
  • Phone: 812-760-5478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number896175
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: